Patient Outcomes in Incomplete Cervical Spinal Cord Injury Without Instability. a Retrospective Multi-center Observational Cohort Study

Introduction: This study explores the rising incidence of cervical incomplete spinal cord injuries like Central Cord Syndrome (CCS) in older patients. To address CCS’s heterogeneity, it proposes classifying cervical spinal cord injury without instability (SCIWI) for a more homogeneous group and compares their demographics, injury characteristics, and in-hospital outcomes to other incomplete cervical SCI subtypes.

Methods: We conducted a multicenter observational study using data from trauma centers in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) from 2010 to 2020. Patients over 16 years with cervical spinal cord injuries were included. Abbreviated Injury Scale (AIS) codes identified patients with cervical fractures. The cohort was divided into two groups: those with spinal column injury (fracture or dislocation) and those without instability (SCIWI). Univariate comparisons were made using t-tests for continuous variables and Chi-square tests for categorical variables.

Results: We identified 26,677 incomplete cervical SCI patients, of whom 11,628 had cervical fractures. Hospital complications occurred in 1,886 (16.2%) patients with fractures compared to 658 (8.6%) without fractures (OR 0.49, 95% CI: 0.44-0.54, p < 0.01). Immobility-related complications were more frequent in the fracture group (8.8%) than in the non-fracture group (4.8%) (OR 0.52, 95% CI: 0.46-0.59, p < 0.01). Surgical site infections occurred in 1.1% of patients with fractures and 0.5% in the non-fracture group (OR 0.47, 95% CI: 0.30-0.74, p < 0.01). Patients with fractures had longer ICU stays (9.4 ± 9.9 vs. 6.7 ± 7.0 days, p < 0.01), more days on mechanical ventilation (10.7 ± 12.3 vs. 8.3 ± 9.8 days, p < 0.01), and longer hospital stays (14.8 ± 15.1 vs. 11.1 ± 11.5 days, p < 0.01).

Conclusion : This study demonstrates greater morbidity associated with cervical incomplete spinal cord injuries with fractures compared to those without, including higher rates of complications, surgical site infections, and longer ICU and hospital stays. This suggests that SCIWI is a distinct clinical entity, impacting patient management and rehabilitation.